Network Patient Representative (NPR) Program Overview
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- Paula Parker
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1 1 Network Patient Representative (NPR) Program Overview What is the NPR program? s Patient Advisory Committee (PAC) developed the Network Patient Representative (NPR) program to help spread educational information to patients and provide them with additional support by a fellow patient in their dialysis clinic. The Network s NPR program is made up of NPRs from across Iowa, Kansas, Missouri, and Nebraska. Who are NPRs? NPRs are individuals that are on dialysis or have had a kidney transplant. They volunteer at their dialysis clinic working with staff to help improve the patient experience and share patient education. NPRs can also serve as peer mentors to fellow patients by sharing their experiences and providing support and encouragement. NPRs are role models in their clinic because of their positive outlook and their desire to learn as much about their kidney disease and treatment as they can to improve their quality of life. What are the responsibilities of an NPR? It is really up to the NPR how involved they want to get, but at minimum we ask that NPRs do the following: Share educational materials from the Network and their clinic with other patients (such as posting info on a bulletin board) Be available to give support to new and current patients by phone, , or in-person Join the monthly NPR Connection Call the first Tuesday of the month to receive Network updates and to discuss ideas with other NPRs Refer patients with questions or concerns to appropriate clinic staff (avoid giving medical advice) For more information or to file a grievance, please contact the at: 920 Main Street, Suite 801, Kansas City, MO Toll-free Patient Line (800) net12@nw12.esrd.net heartlandkidney.org
2 2 Network Patient Representative (NPR) Program Q&A: 1. How do I apply to become an NPR? Talk to your clinic staff about your interest. Then you need to complete the NPR Interest Form and ask a staff member to fill out the Staff Nomination Form. Both forms should be sent together to the Network either by mail or fax. 2. How will I know if I am approved? You will hear from the Network within 2 weeks and will receive an NPR Starter Kit folder sent to your mailing address. 3. What if my clinic already has an NPR, can we have more than one? Yes, there can be more than one NPR at a clinic, but we advise only one per shift. NPRs at the same clinic can work together to plan activities. 4. What are current NPRs doing to serve at their dialysis clinic? NPRs do all sorts of things at their clinic depending how much time they have. You can get creative but here are some examples: maintaining the patient bulletin board with announcements, education, and recipes working with their social worker to welcome new patients organizing patient social gatherings and/or outings writing articles for the clinic s monthly newsletter talking with patients that are having a difficult time with dialysis helping staff plan fun activities at the clinic sharing ideas with the Network about patient projects and/or resources Are you interested in joining a group of dedicated patients across the Network to help improve the patient experience at your dialysis clinic? Become a Network Patient Representative (NPR) TODAY! For more information or questions, please contact Ellie Vail, NPR Program Coordinator, toll free at ext. 709 or by at evail@nw12.esrd.net. This resource was (created, developed, compiled, etc.) while under contract with Center for Medicare and Medicaid Services, Baltimore, Maryland. Contract HHHSM NW012C. The contents presented do not necessarily reflect CMS policy.
3 3 Network Patient Representative (NPR) Statement of Interest Form (Please print clearly) Name: Address: City: Birthday (month/day): Phone: State/Zip: Dialysis clinic or transplant center name: Facility street address: Facility city/state/zip: Nominating staff member name: Current treatment type: Others: How long have you been on dialysis? Help get to know you and tell us a little about yourself: Why are you interested in becoming an NPR for your dialysis clinic? Please continue to the next page.
4 4 What are you looking forward to doing the most with your new role as NPR? I have read the NPR Program Overview and understand my role as an NPR. Signature: Date: Now that you have completed your portion of the NPR application, you need to ask a staff member at your dialysis clinic or transplant center to fill out the Staff Nomination form. Once you have both forms completed, you may mail the application or ask a staff member to fax it. Return this Statement of Interest and the Staff Nomination form to: Attn: NPR Program 920 Main St. Suite 801 Kansas City, MO Fax: Thank you for your interest in becoming an NPR at your clinic. Network staff will be in contact with you soon. If you have any questions, contact Ellie Vail toll-free at (800) or at evail@nw12.esrd.net. For more information or to file a grievance, please contact the at: 920 Main Street, Suite 801, Kansas City, MO Toll-free Patient Line (800) net12@nw12.esrd.net heartlandkidney.org This resource was (created, developed, compiled, etc.) while under contract with Center for Medicare and Medicaid Services, Baltimore, Maryland. Contract #HHSM NW012C. The contents presented do not necessarily reflect CMS policy.
5 5 Network Patient Representative (NPR) Staff Nomination Form Patient Info: Patient Nominee: Address: City/State/Zip Phone: *Clinic Medicare Provider Number (CCN): (this is required to help the Network monitor the spread of the NPR Program among clinics) Recommending Staff Member Contact Info: Name: Title: Dialysis Clinic: Address: City/State/Zip Phone: Total number of patients at unit: (this will help if we send resources for distribution) Why do you think your patient nominee would make a good Network Patient Representative (NPR) for your clinic? By nominating (insert patient nominee), I agree to encourage their involvement at our clinic and support their efforts to improve the patient experience. I will also be the Network s staff contact regarding the NPR Program at our clinic. Signature: Date: Please return this form with the Patient s NPR Statement of Interest form to: Attn: NPR Program 920 Main St. Suite 801 Kansas City, MO Fax: If you have any questions, please contact Ellie Vail at or evail@nw12.esrd.net.
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